CES Device

  • CES Device
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CES Device

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Mild cranial electrical stimulation (CES) has been safely used for many years for the treatment of a wide variety of conditions. Systematic research has shown that CES devices are very effective for treatment of anxiety, depression and sleep quality problems. FDA approved, the CES units available through SoundHealth Products are easy to use, offer the two most effective treatment frequencies and have timing options that permit use for assisting in sleep onset.

In addition to helping with clinical disorders, the CES devices have been found to help with general relaxation, concentration and retention of information.

Easy to use, just attach clips to ear lobes and adjust amplitude to comfortable level.

Instructions

To view the CES Quick Start Instructions, click here

CES Connector Set

The Sound Health Products Cranial Electrical Stimulation (CES) unit can be used for electrical stimulation of acupuncture points (electroacustim) through the Braindryvr Cascade. The adapter plugs into the same output on the CES unit that is used for the ear stimulation cable. The CES adaptor cable terminates at a 3.5mm stereo plug that connects directly to the “Input” on the Braindryvr Cascade.

The CES unit should be set for 100Hz and the amplitude can be set as determined by the clinician. Generally, the stimulation level should be just at feeling threshold for the client, although some therapists prefer different stimulation levels depending on the acupuncture meridian.

Supporting Research

 

Amr, M., El-Wasify, M., Elmaadawi, A. Z., Roberts, R. J., & El-Mallakh, R. S. (2013) Cranial electrotherapy

          stimulation for the treatment of chronically symptomatic bipolar patients. The Journal of ECT, Vol 29(2),

          e31-e32.

Objective: The aim of this study was to determine if cranial electrotherapy stimulation (CES) is beneficial in chronically symptomatic bipolar (CSBP) subjects. Methods: A retrospective chart review of all consecutive CSBP subjects who were prescribed CES collected demographic and clinical information. Results: The Clinical Global Impression improved significantly [mean (SD), 2.7 (0.6) at baseline vs 2.0 (0.0), t = 0, P < 0.001], but mood symptoms change minimally. There were very few adverse effects of CES. Conclusions: Patients with CSBP continue to experience symptoms with CES but also are modestly improved. 

 


Kirsch, D. L., & Nichols, F. (2013) Cranial electrotherapy stimulation for treatment of anxiety, depression, and

        insomnia. Psychiatric Clinics of North America, Vol 36(1), 169-176. doi: 10.1016/j.psc.2013.01.006.

Cranial electrotherapy stimulation is a prescriptive medical device that delivers a mild form of electrical stimulation to the brain for the treatment of anxiety, depression, and insomnia. It is supported by more than 40 years of research demonstrating its effectiveness in several mechanistic studies and greater than 100 clinical studies. Adverse effects are rare (<1%), mild, and self-limiting, consisting mainly of skin irritation under the electrodes and headaches. Often used as a stand-alone therapy, because results are usually seen from the first treatment, cranial electrotherapy stimulation may also be used as an adjunctive therapy. 



Barclay, T. H., & Barclay, R. D. (2013) A Phase IV Clinical Trial of Cranial Electrotherapy Stimulation for Anxiety

        Disorders. American Psychological Association (APA). doi: 10.1037/e618722013-0012013.

This study was a Phase IV Independent Clinical Trial registered at Clinicaltrials.gov, NCT01533415, examining the effectiveness of the Alpha-Stim Cranial Electrotherapy Stimulation Device in the treatment of anxiety for the purposes of FDA reclassification. Anxiety disorders are widespread and the most common mental disorders with lifetime prevalence rates ranging from 13.6% to 28.8%. Medication is the standard treatment for anxiety disorders. Cranial electrotherapy stimulation (CES) offers an alternative to the traditional medication approach and can often be used to augment psychotherapy. CES is considered a noninvasive procedure that involves the application of pulsed, low amplitude electrical current to the head using electrodes placed on the earlobe. Electrical stimulation is usually less than 1 milliampere at 0.5 or 100 Hz from a 9 volt battery. CES received approval by the Food and Drug Administration (FDA) for the treatment of depression, anxiety, and insomnia in 1979. Since this time there have been many studies on the use of CES with over 160 published human research studies reporting significant results. In an attempt to address some of the limitations of previous studies, the objective of this study was to address efficacy by increasing the sample and using a sham treatment within a clinical setting. Previous research has mainly examined the effects of CES on a specific disorder. However, within a clinical setting, rarely do patients present with a single diagnosis. This study examined the effectiveness of CES within a clinical setting by using a 5 week double-blind design using over 100 participants. The Structured Clinical Interview for Axis I Disorders (SCID-I) was used to confirm a primary diagnosis of an anxiety disorder. The study also used the Hamilton Rating Scale for Anxiety (HAM-A) and Hamilton Depression Rating Scale 17 (HAM-D-17) for baseline measurements and at weeks, one, three, and five. Response to treatment was defined as a reduction of 30% or more on these measures. Medication was a covariate. Final data analysis will consist of a repeated measures design that will likely use a general linear model in SPSS and hierarchical linear and quadratic growth models to assess individual change. Cross-validation of quadratic will occur via the estimation of a piecewise linear growth models to assess whether growth is more variable for one period over another during the study time frame. Optimal design software will be used to make a preliminary determination that 100 or more participants in a randomized quadratic growth individual change model will achieve a power of .80 to .95 for a study expecting an effect size of between 0.6 to .80. We conducted exploratory ANOVAs on the HAM-A and HAM-D for each of the three assessment period's gain score and one overall gain score. Preliminary results of sample equivalence for experimental and control group (functional device vs. non-functional device) was assessed using mean difference analysis within this preliminary data. Results show significant decrease in HAM-A and HAM-D scores within the experimental group. The significance value for decrease in symptoms is .001 for HAM-A scores and .05 for HAM-D scores. 



Bracciano, G., Chang, W-P., Kokesh, S., Martinez, A., Meier, M., & Moore, K. (2012) Cranial electrotherapy

        stimulation in the treatment of posttraumatic stress disorder: A pilot study of two military veterans. Journal

        of Neurotherapy, Vol 16(1), Jan 2012, 60-69. doi: 10.1080/10874208.2012.650100.

This case study investigated the effects of cranial electrotherapy stimulation (CES) on the prevalence and intensity of posttraumatic stress disorder (PTSD) symptoms and self-perceived improvement of performance and satisfaction in daily activities in war veterans. Two male Caucasian veterans (ages 54 and 38) diagnosed with PTSD participated in these case studies with a pretest–posttest design. The Canadian Occupational Performance Measure (COPM) and the PTSD Symptom Scale–Interview (PSS-I) were administered before and after the 4-week CES treatment. The participants self-administered the 4-week CES treatment protocol using Alpha-Stim SCS CES device in their home for 20 to 60 min a day, 3 to 5 days a week with a comfortable, self-selected, current level between 100 and 500 microamperes. They were asked to document the settings and responses in a daily treatment log. Through visual trend analysis and change scores, the results revealed daily PTSD symptoms decreased in frequency and severity for both participants from PSSI-I and daily treatment log. Self-perceived efficacy of performance and satisfaction as measured by the COPM also improved in the 54-year-old participant as his change scores (performance: +5.4; satisfaction: +7.9) were over the clinical significance of 2 points of COPM. Both participants reported a decrease in PTSD symptoms and an overall improvement in self-perceived occupational performance after a trial of CES. Findings from this study suggest that future research could contribute to the role of occupational therapists using CES in the treatment of veterans with PTSD. This preliminary study, if confirmed, indicates that CES could provide occupational therapists with a safe and effective way to reduce the symptom burden of PTSD while facilitating occupational performance for a rapidly increasing population of war veterans. 



Gunther, M., & Phillips, K. D. (2010) Cranial electrotherapy stimulation for the treatment of depression. Journal

        of Psychosocial Nursing and Mental Health Services, Vol 48(11), Nov 2010, 37-42. doi:

        10.3928/02793695-20100701-01.

More prevalent in women than men, clinical depression affects approximately 15 million American adults in a given year. Psychopharmaceutical therapy accompanied by psychotherapy and wellness interventions (e.g., nutrition, exercise, counseling) is effective in 80% of diagnosed cases. A lesser known adjunctive therapy is that of cranial electrotherapy stimulation (CES). The major hypothesis for the use of CES in depression is that it may reset the brain to pre-stress homeostasis levels. It is conjectured that the pulsed electrical currents emitted by cranial electrical stimulators affect changes in the limbic system, the reticular activating system, and/or the hypothalamus that result in neurotransmitter secretion and downstream hormone production. While evidence is good for applied research, basic research about the mechanisms of action for CES remains in its infancy. A review of the literature provides an overview of current research findings and implications for clinical mental health practice. 



Shultz, J. C. (2010) The effects of cranial electrotherapy stimulation on attention: A double-blinded, placebo-

        controlled investigation. The Sciences and Engineering, Vol 71(6-B) 3956.

This is a double-blind, placebo-controlled, matched samples, pretest-posttest control group design study that examined the effects of Cranial Electrotherapy Stimulation (CES) on attention. The population sample was non-clinical, drawn from The Chicago School of Professional Psychology. All volunteers completed the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) to exclude participants with mild and severe symptoms of anxiety and depression. A baseline IVA+Plus and POMS assessed for attention and mood prior to any CES treatment. Participants were control-matched to a sham-CES (placebo) condition or a treatment-CES condition, while controlling for female participants' phase in menstrual cycle. After a one-hour application of CES at 100 RA, 0.5 hz, participants were administered a second IVA+plus and second POMS. Results show a statistically significant increase in auditory attention for the treatment group as compared to the placebo group. This research may have significant implications for the use of CES to enhance attention. 



Bystritsky, A., Kerwin, L,. & Feusner, J. (2008) A pilot study of cranial electrotherapy stimulation for generalized

        anxiety disorder. Journal of Clinical Psychiatry, Vol 69(3), Mar 2008, 412-417. doi: 10.4088/JCP.v69n0311.

Background: Cranial electrotherapy stimulation (CES) is a noninvasive procedure that has been used for decades in the United States to treat anxiety, depression, and insomnia in the general population. Whether CES is an effective treatment for patients with a DSM-IV diagnosis of generalized anxiety disorder (GAD) has not previously been explored. The goal of this study was to evaluate the efficacy of CES in alleviating anxiety in patients with DSM-IV-diagnosed GAD. Method: Twelve patients from 29 to 58 years of age with a DSM-IV diagnosis of GAD were enrolled from August 2005 to March 2006 through the University of California, Los Angeles (UCLA) Anxiety Disorders Program. Cranial electrotherapy stimulation treatment was administered for 6 weeks using the Alpha-Stim Stress Control System at 0.5-Hz frequency and 300-μ1 A intensity. The primary efficacy measures were the Hamilton Rating Scale for Anxiety (HAM-A) and the Clinical Global Impressions-Improvement (CGI-I) scale. Response to treatment was defined as a reduction of 50% or more on the HAM-A and a CGI-I score of 1 or 2 ("much improved" or "very much improved," respectively). Results: Cranial electrotherapy stimulation was associated with a significant decrease in HAM-A scores (t = 3.083, p = .01). At endpoint, 6 patients (50% of the intent-to-treat sample and 67% of completers) had a 50% decrease in HAM-A score and a CGI-I score of 1 or 2.'One additional patient significantly improved in anxiety scores but did not meet criteria for response. Adverse events were generally mild in severity, mostly consisting of headache and nausea. Conclusion: This preliminary study suggests that CES may reduce symptoms of anxiety in GAD. We hope that these preliminary results will encourage further research to explore the use of CES in clinical settings. 



Childs, A., & Price, L., (2007) Cranial electrotherapy stimulation reduces aggression in violent neuropsychiatric

        patients. Primary Psychiatry, Vol 14(3) 50-56.

The study sought to determine if 3 months of daily cranial electrotherapy stimulation (CES) treatment reduced aggression in violent neuropsychiatric patients in a maximum security hospital. CES was used to treat 48 chronically aggressive neuropsychiatric patients in a maximum security psychiatric hospital. Retrospective chart review compared 3 months pre-treatment with 3 months of active therapy. Early patients had responded positively to CES with a 41% reduction in episodes of violence (P<.001), a 40% reduction in episodes requiring restraint (P<.001) and seclusion (P<.05), and 42% fewer as-needed emergency medications (P<.01). A subgroup of 10 treatment-resistant psychotic patients, who attacked without warning or apparent motivation and were designated as having sudden assault syndrome, were 48% less violent on CES (P<.001). CES has significant anti-aggressive effects in violent neuropsychiatric patients, who are often refractory to medication. This safe, easy-to-administer treatment can benefit long-term severely ill patients. 



Tan, G., Alvarez, J. A., & Jensen, M. P. (2006) Complementary and Alternative Medicine Approaches to Pain

        Management. Journal of Clinical Psychology, Vol 62(11) 1419-1431. doi: 10.1002/jclp.20321.

This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and self-hypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment.



Childs, A. Cranial electrotherapy stimulation reduces aggression in a violent retarded population: A preliminary

        report. doi: 10.1176/appi.neuropsych.17.4.548

The Journal of Neuropsychiatry and Clinical Neurosciences, Vol 17(4), 2005, 548-551.
Nine aggressive, retarded patients refractory to conventional care at a maximum security hospital were given a 3-month course of cranial electrotherapy stimulation. Aggressive episodes declined 59% from baseline; seclusions were down 72%; restraints were down 58%; and use of prescribed-as-needed sedative medications decreased 53%. The most dramatic change was that of a disorganized, schizophrenic patient whose aggressive episodes declined from 62 to 9, seclusions from 53 to 8, restraints from 9 to 1 and PRNs from 25 to 1. No patients discontinued cranial electrotherapy stimulation (CES) because of side effects. This preliminary report indicates that CES appears to be an efficacious, safe, and cost-effective addition to the treatment regimen in this patient population. 



Gilula, M. F., & Kirsch, D. L. (2005) Cranial Electrotherapy Stimulation Review: A Safer Alternative to

        Psychopharmaceuticals in the Treatment of Depression. Journal of Neurotherapy, Vol 9(2), 2005, 7-26.

        doi:10.1300/J184v09n02_02.

The use of Cranial Electrotherapy Stimulation (CES) to treat depression and anxiety is reviewed. The data submitted to the Federal Drug Administration (FDA) for approval of medication in the treatment of depression are compared with CES data. Proposed method of action, side-effects, safety factors, and treatment efficacy are discussed. The results suggest there is sufficient data to show that CES technology has equal or greater efficacy for the treatment of depression compared to antidepressant medications, with fewer side effects. A prospective research study should be undertaken to directly compare CES with antidepressant medications and to compare the different CES technologies with each other. 



Overcash, S. J. (2005) The Effect of ROSHI Protocol and Cranial Electrotherapy Stimulation on a Nine-Year-Old

        Anxious, Dyslexic Male with Attention Deficit Disorder: A Case Study. Journal of Neurotherapy 9(2) 63-77.

This case study describes diagnosis and treatment of a nine-year-old male with poor reading achievement, attention deficit disorder, and severe generalized anxiety disorder. The goal of the treatment was to significantly increase this young man's reading achievement, reduce his anxiety to a normal level, and to reduce his ADD symptoms so he could concentrate at a normal level for his age and sex. Psychological testing was administered and QEEGs were recorded before and after treatment intervention. The patient was treated using the ROSHI Complex Adaptive Protocol, Cranial Electrotherapy Stimulation, and Project Read Reading Program. This multimodal treatment lasted six months with follow-up testing administered 15 months after initial diagnostic testing. Before and after objective psychological test results and QEEG changes indicate significant improvement in reading achievement, significant math and spelling achievement, significant reduction in anxiety, and significant reduction in ADD symptoms.



Schmitt, R., Capo, T. & Boyd, E. (1986), Cranial Electrotherapy Stimulation as a Treatment for Anxiety in

        Chemically Dependent Persons. Alcoholism: Clinical and Experimental Research, 10: 158–160. doi:

        10.1111/j.1530-0277.1986.tb05064.

Cranial electrotherapy stimulation (CES) is reported to be an effective treatment for anxiety, a major presenting symptom among chemically dependent patients. In this study, 40 inpatient alcohol and/or poly-drug users were given CES or sham CES in a double blind design. An additional 20 patients served as normal hospital routine controls. Dependent measures of anxiety were the Profile of Mood States, the Institute for Personality and Ability Testing Anxiety Scale, and the State/Trait Anxiety Index. CES-treated patients showed significantly greater improvement on afl anxiety measures than did either control group. There were no differences in response between older and younger patients, or between the primarily drug or alcohol abusers. No placebo effect was found on any of our measures. It is concluded that CES is a clinically significant addition to the treatment regimen for this patient population.



Smith R.B., Tiberi A., & Marshall J. (1994) The use of cranial electrotherapy stimulation in the treatment of

        closed-head-injured patients. Brain Injury, 1994, 8(4) 357-361. doi: 10.3109/02699059409150986.

This double-blind study sought to discover if cranial electrotherapy stimulation (CES), which is a known treatment of depression, anxiety and insomnia in non-head-injured patients, could be an effective, drug-free treatment of stress-related symptoms in the closed-head-injured (CHI) patient. In this study 10 CHI patients treated for 45 min daily, 4 days a week for 3 weeks, responded significantly on all negative mood factors of the Profile Of Mood States, while five sham-treated and six placebo controls did not. While the majority of the patients were known seizure cases, no patient suffered a seizure during CES therapy. No placebo effects were found, nor were any negative effects from CES treatment seen.



Rintala, D. H., Tan, G., Willson, P., Bryant M. S., & Lai, E. C. H. (2010) Feasibility of Using Cranial

        Electrotherapy Stimulation for Pain in Persons with Parkinson's Disease. Parkinson's Disease, vol. 2010,

        Article ID 569154, 8 pages, 2010. doi:10.4061/2010/569154.

Objectives. To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinson's disease (PD) with cranial electrotherapy stimulation (CES). Design. Randomized, controlled, double-blind trial. Setting. Veterans Affairs Medical Center, Community. Participants. Nineteen persons with PD and pain in the lower back and/or lower extremities. Thirteen provided daily pain rating data. Intervention. Of the thirteen participants who provided daily pain data, 6 were randomly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks. They recorded their pain ratings on a 0-to-10 scale immediately before and after each session. Main Outcome Measure. Average daily change in pain intensity. Results. Persons receiving active CES had, on average, a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES (Wilcoxon = − 2 . 2 0 , = . 0 2 8 ). Conclusion. Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain. A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES. Guidelines for future studies are provided.

 


Datta, A. D., Guleyupoglu J. P., Berkan B., Marom F., & Felipe. (2013) Cranial electrotherapy stimulation and

        transcranial pulsed current stimulation: A computer based high-resolution modeling study. NeuroImage, Vol

        65: 280-287.

The field of non-invasive brain stimulation has developed significantly over the last two decades. Though two techniques of noninvasive brain stimulation — transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) — are becoming established tools for research in neuroscience and for some clinical applications, related techniques that also show some promising clinical results have not been developed at the same pace. One of these related techniques is cranial electrotherapy stimulation (CES), a class of transcranial pulsed current stimulation (tPCS). In order to understand further the mechanisms of CES, we aimed to model CES using a magnetic resonance imaging (MRI)-derived finite element head model including cortical and also subcortical structures. Cortical electric field (current density) peak intensities and distributions were analyzed. We evaluated different electrode configurations of CES including in-ear and over-ear montages. Our results confirm that significant amounts of current pass the skull and reach cortical and subcortical structures. In addition, depending on the montage, induced currents at subcortical areas, such as midbrain, pons, thalamus and hypothalamus are of similar magnitude than that of cortical areas. Incremental variations of electrode position on the head surface also influence which cortical regions are modulated. The high-resolution modeling predictions suggest that details of electrode montage influence current flow through superficial and deep structures. Finally we present laptop based methods for tPCS dose design using dominant frequency and spherical models. These modeling predictions and tools are the first step to advance rational and optimized use of tPCS and CES.



Schroedera, M. J., and Barrb, R. E. (2001) Quantitative analysis of the electroencephalogram during cranial

        electrotherapy stimulation. Clinical Neurophysiology, 112(11) 2075–2083.

Objective: Normal individuals were used to quantitate electroencephalographic (EEG) changes during concurrent administration of 0.5and 100 Hz cranial electrotherapy stimulation (CES).

Methods: Twelve normal, right-handed males were used in a randomized, double-blind crossover design study. A 3 amplifier system incorporating noise-cancellation was used to collect one channel of EEG (O1-Cz configuration) for 30 min. Either 0.5, 100 Hz, or sham CES treatment was administered for 20 min of each session. Statistical analyses were applied to time- and frequency-domain EEG variables.

Results: Relative to sham control, 0.5 and 100 Hz CES caused the alpha band mean frequency to shift downward. Additionally, 100 Hz CES also caused a decrease of the alpha band median frequency and beta band power fraction.

Conclusions: Both 0.5 and 100 Hz CES provide frequency distribution shifts that suggest beneficial changes in mental state. However, compared to 0.5 Hz CES, 100 Hz CES effected a greater overall change. It is suggested that similar tests be performed on individuals with various behavioral and neurological disorders to determine if comparable EEG changes can be realized and correlated with beneficial effects of CES therapy. 



Taylor A. G., Anderson, J. G., Riedel, S. L., Lewis, J. E., Kinser, P. A., Bourguignon, C. (2013) Cranial Electrical

        Stimulation Improves Symptoms and Functional Status in Individuals with Fibromyalgia. Pain Management

        Nursing 14( 4) 327-335. DOI: 10.1016/j.pmn.2011.07.002

To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on reducing pain and its associated symptoms in fibromyalgia (FM), we conducted a randomized, controlled, three-group (active CES device, sham device, and usual care alone [UC]), double-blind study to determine the potential benefit of CES therapy for symptom management in FM. Those individuals using the active CES device had a greater decrease in average pain (p = .023), fatigue (p = .071), and sleep disturbance (p = .001) than individuals using the sham device or those receiving usual care alone over time. Additionally, individuals using the active CES device had improved functional status versus the sham device and UC groups over time (p = .028).



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    I'm fairly jaded by 'gimmicks' and not easily impressed. Spectra however is really special and very impressive. Loved the instant meditative mental state that was stimulated. ...just the thing [that] alcohol treatment centres need. Unless there's ...
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